MedicaidPrior AuthMedium impact
Crysvita® (burosumab) (New)
Humana·LA · Endocrinology, Pediatrics, Rheumatology +1 more·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Crysvita (burosumab) under Louisiana Medicaid, requiring specific diagnostic criteria including FGF23 levels >30 pg/mL and reduced TmP/GFR ratios for X-Linked Hypophosphatemia and Tumor-Induced Osteomalacia treatment coverage.
Action Required
Before May 1, 2026: Billing team must implement prior authorization requirements for Crysvita (burosumab) prescriptions for Louisiana Medicaid patients. Providers must document FGF23 levels >30 pg/mL, reduced TmP/GFR ratios, and specific clinical symptoms before prescribing. Update EMR templates to include required diagnostic criteria checklist. Claims will require prior authorization approval for coverage.